From the Guidelines
Ramsay Hunt syndrome should be treated promptly with systemic antiviral therapy and systemic steroids to improve outcomes and reduce the risk of complications. This condition is a painful viral infection caused by the varicella-zoster virus, affecting the facial nerve near one ear, and typically presents with a painful rash inside the ear canal and outer ear, facial weakness or paralysis on the affected side, and hearing loss or tinnitus 1. The management of Ramsay Hunt syndrome involves prompt systemic antiviral therapy and systemic steroids, as stated in the clinical practice guideline for acute otitis externa 1.
Key Considerations
- The condition requires early treatment, ideally within 72 hours of symptom onset, to significantly improve outcomes and achieve at least partial recovery of facial function.
- Treatment may include antiviral medications, such as acyclovir, valacyclovir, or famciclovir, combined with corticosteroids like prednisone.
- Pain management with analgesics is also crucial, and eye protection with artificial tears and eye patches may be necessary if facial weakness prevents complete eye closure.
- Physical therapy can help maintain muscle tone during recovery, and complete recovery may take weeks to months.
Differential Diagnosis
- Other causes of otalgia or otorrhea that may mimic acute otitis externa, such as furunculosis, viral infections, temporomandibular joint syndrome, and upper aerodigestive tract cancer, should be considered in the differential diagnosis 1.
- A complete head and neck examination with visualization of the mucosal surfaces of the head and neck, assessment of any neck masses, and palpation of the tongue base is recommended to rule out other potential etiologies.
From the Research
Definition and Symptoms of Ramsay Hunt Syndrome
- Ramsay Hunt syndrome is defined as peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) or in the mouth 2
- Symptoms include tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus, in addition to facial paralysis and rash 2
Causes and Treatment of Ramsay Hunt Syndrome
- The syndrome is caused by varicella zoster virus (VZV) 2
- Treatment with prednisone and acyclovir may improve outcome, although a prospective randomised treatment trial remains to be undertaken 2
- Studies suggest that combination therapy with antiviral medication and corticosteroids improves the outcome for patients with Ramsay Hunt syndrome 3
- Early administration of acyclovir-prednisone has been shown to reduce nerve degeneration and improve facial nerve recovery 4
Comparison of Antiviral Agents for Ramsay Hunt Syndrome
- A retrospective study compared clinical outcomes in patients with Ramsay Hunt syndrome treated with acyclovir and famciclovir, and found that the overall complete recovery rate was significantly higher with famciclovir than with acyclovir 5
- Another study found that treatment with acyclovir intravenously for 7 days resulted in an overall recovery rate of 82.6% 6